Pain assessment remains a challenge to medical professionals and received much attention over the past decade. Effective management of pain remains an important indicator of the quality of care provided to patients. Pain scales are useful for clinically assessing how intensely patients are feeling pain and for monitoring the effectiveness of treatments at different points in time. A number of questionnaires have been developed to assess chronic pain. They are mainly used as research tools to assess the effect of a treatment in a clinical trial but may be used in specialist pain clinics. This review comprises the basic information of pain intensity scales and questionnaires. Various pain assessment tools are summarized. Pain assessment and management protocols are also highlighted.

One of the most severe pains experienced by a woman is that of childbirth. Providing analgesia for labor has always been a challenge more so because of the myths and controversies surrounding labor. It is imperative to understand the pain transmission during various stages of labor in order to select a proper technique for providing labor analgesia. The adverse effects of labor pain are numerous and affect both the mother as well as the fetus. Currently lumbar epidural is considered to be the gold standard technique for labor analgesia. Local anaesthetics like bupivacaine and ropivacaine are commonly used and adjuvants like clonidine, fentanyl and neostigmine have been extensively studied. However, despite being so popular, epidural analgesia is not without complications, with hypotension being the most common. Other complications include accidental dural puncture, infection, intravascular placement, high block and epidural hematoma. Other neuraxial techniques include continuous caudal analgesia, and combined spinal epidural analgesia. The numerous studies investigating the various aspects of this method have also served to dispel various myths surrounding epidural analgesia like increased incidence of cesarean section and instrumental delivery, prolongation of labor and future back pain. The future of labor analgesia lies in the incorporation of ultrasound in identifying the epidural space helping in proper catheter placement. The keywords "labor epidural" in the PUBMED revealed a total of 5018 articles with 574 review articles and 969 clinical trials. The relevant articles along with their references were extensively studied.

Objectives:Moringa oleifera is a highly valued plant distributed in many countries of the tropic and subtropics. Moringa oleifera leaves are a potential source of phytochemical ingredients claimed to have analgesic property. Pain is an unpleasant sensation, which in many cases represents the only symptom for the diagnosis of several diseases. Therefore analgesic drugs lacking the side effect as alternative to nonsteroidal anti-inflammatory drugs (NSAIDs) and opiates are in demand by the society. The present study is undertaken to evaluate the analgesic activity of Moringa oleifera using acetic acid induced writhing test and Eddy's hot plate test. Materials and Methods: It is a randomized control study. The present study was done using two experimental models. The albino mice were divided into six groups, each group consisting of 6 mice. A total of 36 mice were used in each of the two experimental models. Group I: Control (normal saline given orally at 2 ml/kg body weight); Group II: Standard (diclofenac 10 mg/kg i.p/ morphine 1 mg/kg i.p); Group III, IV, V, VI (ethanolic extract of Moringa oleifera (EMO) 50, 100, 200, 400 mg/kg, respectively). The EMO leaves were administered at 50, 100, 200, 400 mg/kg doses orally 1 hour before the experiments. For peripheral analgesic effect, acetic acid induced writhing test was used. The central analgesic effect was screened using Eddy's hot plate method. The standard drug used in acetic acid induced writhing test was diclofenac and in Eddy's hot plate test was morphine. Results: The EMO leaf showed significant (P < 0.01) analgesic activity at 100, 200, 400 mg/kg in the acetic acid induced writhing test showing 32.21%, 59.71% and 78.61% inhibition of writhes, respectively in comparison with the control. In the Eddy's hot plate test EMO at 400 mg/kg showed significant (P < 0.01) analgesic activity from 15 min to 90 min with a mean rank ranging from 28.92 to 26.00, second mean rank following morphine in comparison with control. In both the tests, EMO showed significant (P < 0.01) analgesic activity in a dose-dependent manner. Conclusion: The ethanolic leaf extract of Moringa oleifera exhibited analgesic activity in both models showing its both central and peripheral analgesic actions.

Background: The 'cough trick' (CT) technique is used in reducing intramuscular prick (IMP) pain during vaccinations and also for brief painful procedures like subcutaneous injection, intravenous cannulation, and so forth. We present the utility study of this technique in male adolescents. Materials and Methods: A Randomized Crossover Volunteer Study of 50 early adolescent male children (age 11-13) receiving immunizations was performed. Participants were recruited from four outpatient pediatric clinics. The strategy required a single "warm-up" cough of moderate force, followed by a second cough that coincided with needle puncture. The principle outcome was self-reported pain. Results: Paired 't' test revealed that the procedure was effective at a statistically and clinically significant level for participants. Children found the procedure acceptable and effective. Conclusions: The results of this study suggest that the CT can be an effective strategy for the reduction of pain for male adolescent children undergoing routine immunizations. However, additional research is needed with a larger sample size with different age groups and also including girl children.

Background: Pain of upper abdominal surgeries not only distresses the patient but also results in inadequate respiratory efforts and cough reflex. So pain relief in these surgeries bears more significance than mere patient comfort. Gabapentine has been found effective for post-operative pain relief in many surgeries including spine surgeries, radical mastectomies etc. We carried out this study to find out the effectiveness of gabapentine for post-operative pain relief in upper abdominal surgeries. Materials and Methods: The present study was randomized, double-blind and prospective, designed to evaluate synergistic effect of gabapentine and total requirement of tramadol in various upper abdominal surgeries. The study was carried out in 50 patients of American Society of Anesthesiologists (ASA) grade I and II of either sex, aged between 20 to 60 years, divided into two groups of 25 patients each. Group P (placebo group) received oral placebo capsule (3 placebo capsule) and Group G (study group) received oral gabapentine capsule (1200 mg) (3 capsules of 400 mg each) pre-operatively 2 hrs before surgery. Patients were observed 24 hrs postoperatively for pain via visual analog scale (VAS), tramadol requirement (consumption) and side effects. Results: It was observed that patients in gabapentine group had statistically significant lower pain score at all time interval in comparison to placebo group. It was demonstrated that pre-emptive oral gabapentine significantly reduced tramadol consumption until 24 hrs post-operatively. Mild sedation was observed in gabapentine group but was comparable with Group P. Conclusion: Gabapentine significantly reduces post-operative pain and post-operative tramadol consumption in upper abdominal surgeries. Mild sedation was observed with gabapentine group but was comparable with placebo.

Purpose: The aim of the study was to compare the clinical efficacy of methylprednisolone with ibuprofen to ibuprofen alone on the postoperative sequelae of surgical removal of impacted third molars. Materials and Methods: The present study was conducted on the 35 patients requiring surgical extraction of bilateral impacted third molars attending the Outpatient Department of Oral and Maxillofacial Surgery, Guru Nanak Dev Dental College and Research Institute. The impacted teeth were removed in two sessions at least 3 weeks apart. The selected patients were randomly put on regimen 1 or regimen II at either the first or second surgery in accordance with randomization plan. The measurements and recordings for pain, swelling, and interincisal distance (mouth opening), were made on 1 st , 3 rd , and 7 th day postoperatively on the scales designed for the purpose. The data recorded was compiled and put to statistical analysis. Results: It was observed from the present study that postoperative sequelae, that is, pain, swelling, and trismus was significantly less in the regimen I group than regimen II group on the 1 st and 3 rd postoperative day. Conclusion: The results of this study substantiate the fact that a single class of drugs (nonsteroidal anti-inflammatory drug (NSAID)) is less effective in controlling postoperative inflammatory sequelae than the combination of ibuprofen (NSAID) and methylprednisolone (corticosteroid) following the third molar surgery. Therefore, this pharmaceutical combination should be considered for attenuation of postoperative sequelae in healthy patients undergoing surgical removal of impacted mandibular third molar.

Background and Objective: Pain, after orthopedic surgery, is a severe and leading cause of chronic pain with many attempts to reduce it without a total success. Gabapentin is effective in reducing acute and chronic pain. Fascia iliaca compartment block (FICB) is a simple, rapid, effective, and safe method of achieving excellent pain relief. The purpose of this study is to compare effect of pre-emptive gabapentin with FIC on reducing postoperative pain and morphine consumption in femoral surgery. Materials and Methods: Seventy-eight patients scheduled for elective open reduction internal fixation of femur were enrolled in the study and separated into two groups. The control group received 600 mg of gabapentin orally two hours before surgery and the case group received FICB under general anesthesia. Data, including blood pressure, heart rate, sedation score, visual analogous scale at several hours and first need to analgesic post operatively was collected. Results: The post operation pain in FICB group was significantly lower than gabapentin group (P = 0.000). Patients in FICB group had more of postoperative satisfaction and the time of first need of analgesic and total analgesic consumption was significantly lower than gabapentin group (P < 0.05). There were no significant differences in complications among the study groups. Conclusion: Fascia iliaca compartment block is a safe, low skill and inexpensive way to reduce postoperative pain after femur surgery in the first hours of postoperative and can be a part of multi-modal therapy with no side effects.

Failed back surgery syndrome (FBSS) is a condition of persistent pain following spine surgery as a result of epidural adhesions, nerve root entrapment/inflammation. Transforaminal epidural steroid (TFES), interlaminar/caudal epidural (CE) with local anesthetic, saline, steroid and hyaluronidase are established therapeutic options over re-surgery. We report a 55 years old male patient with FBSS since 10 years. Following informed consent, under fluoroscopy guidance TFES given at L4/5, L5/S1 foramina with 1.5 ml 0.25% bupivacaine + triamcinolone 20 mg. Besides, CE injection of 10 ml 0.25% bupivacaine with 50 mcg fentanyl given using 18 gauge Tuohy's needle. Fifteen minutes later 20 ml of 0.9% cold (2°C) normal saline with hyaluronidase (on day 1) was injected forcefully through epidural catheter, repeated on 2 nd and 3 rd day with triamcenolone 20 mg. 90% pain relief persisted till 8 months with improved quality of life. TFES with successive CE saline can be a good therapeutic option for long term relief in FBSS.

Avascular osteonecrosis (AVN) of the femoral head is one of the most common skeletal complications of kidney transplantation. Patients with hip joint avascular necrosis usually undergo joint arthroplasty. However, if a patient is unfit for surgery due to some comorbidities, hip joint articular branches denervation can be done to control pain and improve functional life. There is a large variation in the contribution as well in the position of the articular branches to hip joint by obturator, femoral, and sciatic nerves. Several authors have proposed percutaneous radio frequency denervation of the hip joint to eliminate pain.In our case, the patient was having an intractable hip joint pain which was not responding to conservative drug therapy as well physiotherapy. In our patient, hip arthroplasty was contraindicated because of the high risk of infection and anticoagulants. After diagnostic block, the pain in his groin and hip disappeared immediately. The patient noted a decrease in pain (Visual Analog Scale, VAS 9-10 to 1-2) and an improvement in the ability to walk. Then we performed percutaneous radio frequency ablation of the articular branches of the obturator nerve and the femoral nerve. Nerve blocks were performed via a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve. Because optimal coagulation requires electrodes to lie parallel to the nerves, a perpendicular approach probably produced only a minimal lesion. A perpendicular approach is likely to puncture femoral vessels. Vessel puncture can be avoided if an oblique pass is used. The patient had improved ability to ambulate and the patient can carry out his daily routine activites at home without much pain and can sleep comfortably. There were no complications like motor deficit, neuritis, bleeding, or infection. Our case report gives few impressions. First, it shows that if radio contrast agent (omnipaque dye) use is restricted or contraindicated, a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve and articular branch of femoral nerve. Second, it confirms the radiological anatomy of articular branches of hip joint. Third, oblique approach is safe and gives optimum lesion.